'Consider going to the field early in your career because the experience will make you a better practitioner.'
What is your professional background and what did you do before joining MSF?
I taught rock climbing, did some mountaineering, and worked for the National Park Service before I decided to go to medical school at age 33. After 13 years working in the U.S., I was ready to work overseas with MSF.
Describe a typical day in one of your assignments
In Liberia, in the 70-bed hospital, my days were spent in the operating room supervising two nurse-anesthetists and performing trauma care. A small part of the day was spent in the wards doing evaluations or sedating patients for minor procedures.
What did you find most challenging about your work in the field?
In my profession, you are used to working with a high level of technology. When you get to the field, you learn to manage with primitive equipment, a staff with basic skills and knowledge, and less sophisticated drugs.
What kind of equipment did you have to administer and monitor anesthetic?
We had a museum-piece anesthetic vaporizer, which was a little canister through which oxygen flows from an oxygen concentrator. It was sometimes difficult to tell how much you’re actually delivering to the patient, so we went by vital signs to check our dosing.
We had a battery-powered oximeter and a manual blood pressure cuff. To fully monitor the patient, you had to rely on palpating pulses, checking mucus membranes and blood color.
Describe what most surprised you in the operating room.
What struck me was the acuteness of severity of cases. People were coming in with illnesses that shouldn’t have been life-threatening, but were because they ignored their sickness or sought medical care in a hospital as a last resort. We had a lot of deaths in the operating room.
Was there a clinically interesting case you worked on, that you would not see in your practice at home?
We had a newborn with a condition called an omphalocoele—failure of the abdominal wall to close—so the child had his intestines hanging out, which had to be corrected or he would die. After three operations, we were able to close the abdominal wall.
What was your experience like living with the team you worked with?
In such an intense work environment with long days, a natural family atmosphere developed quickly regardless that we were strangers at first and from different cultural backgrounds. I enjoyed the camaraderie and found the group very supportive.
Has working with MSF inspired you to refocus your professional path?
I quit my job of 10 years to find a situation which allows me to do field work every couple of years.
How safe did you feel on your assignments?
Most of the places MSF sets up are not the safest places on earth, but it has a 35-year history of working in war and conflict zones. I felt that MSF’s security plan was very well thought out. You are not flung out into the wilderness. What is important is that you play by the rules. I felt safe enough.
Has your perspective about MSF changed now that you’ve been on two assignments?
As a donor before becoming an aid worker, I was impressed with MSF’s financials and transparency. Now that I’ve seen how MSF uses its resources, I can say that I’m even more impressed. MSF does not waste money on things that don’t matter; they spend resources on the bottom line - caring for the patients.
I am in awe of the people who work for MSF. Anesthesiologists go for two months, but administrators, nurses, and logisticians stay for a year or 18 months. It’s incredible to be around that kind of dedication. I really cannot describe the respect I have for people who make MSF a career. It’s a real honor to work with such people.
What character trait will be an asset in the field?
Surgeons and anesthesiologists are used to having very competent support staff to respond exactly right in every situation, but in some field projects, either you are alone, or the local support staff has basic skills, so PATIENCE is key. We have to remind ourselves that our local staff did not have access to the high level of training and education that we were fortunate to have in the U.S. Our task is to work with what they know, teach them so they can be better for the next case, and for them to teach others. Before doing field work, it is important to know if you have this kind of patience.
Do you feel your life has changed after working with MSF?
I’m more sensitive to what people in less developed countries go through on a daily basis and how their lives often hang by a thread. I return home with a new appreciation for life’s beauty and the people around me. I complain less.
What recommendations do you have for anesthesiologists, especially students and residents, who are interested in applying to MSF?
Consider going to the field early in your career because the experience will make you a better practitioner. Your basic skills will be reinforced and you will learn to work without sophisticated equipment.